dental health and medical health relationship

1. 1
Dr. Mohammed Alruby
Dental health
And
Medical health relationship
Prepared by:
Dr Mohammed Alruby
‫امرا‬ ‫ذلك‬ ‫بعد‬ ‫يحدث‬ ‫هللا‬ ‫لعل‬ ‫تدري‬ ‫ال‬
Important medical definitions:

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Dr. Mohammed Alruby
Blood pressure:
Is the force that person’s blood exerts against the walls of their blood vessels, this pressure depends
on the resistance of blood vessels and how the heart has to work
Blood pressure has two numbers:
- Systolic: represent the pressure in blood vessels when heart contract or beats
- Diastolic: represent the pressure in the vessels when the heart rests between beats and
contraction
Hypertension:
Or high blood pressure: is a common condition in which the long term force of blood against your
artery walls is high enough that it may eventually cause health problem such as, heart disease
Heart attack:
Is a death of segment of heart muscle caused by loss of blood supply. The blood usually cut off
when an artery supplying the heart muscles is blocked by blood clot
Aneurysm:
Enlargement of an artery caused by weakness in the arterial wall
Cardiac arrest:
Means heart stop, blood circulation stops, there is no pulse
Cardiomyopathy:
Damaged of heart muscle other than by artery or blood flow problems, may cause by drugs side
effects
Myocarditis:
Inflammation of heart muscle, usually caused by virus, leading to left sided heart failure
Heart arrhythmias:
Abnormal heart rhythm, they may cause the heart beat too fast, creating more work for the heart,
eventually the heart may weaken, leading to heart failure
Atrial fibrillation:
An irregular, often rapid heart beat
Myocardial infarction:
Medical name of heart attack: irreversible death (necrosis) of heart muscle secondary to prolonged
lack of oxygen supply (ischemia)
Heart rate:
One of the vital signs, it measures the number of times / minutes that the heart contract or beats.
It is your pulse rate.
How to count: number of beat in 10 seconds X 6 = number of beats / minutes
Age: 6--15: 70-- 100 beat / minutes
Age: 18 y and over: 60—100 beats / minutes
Respiratory rate:
Number of breaths a person takes / minute, that measured when the person is at rest. Count the
number of breath / minute increasing age as:
From birth to 1 year: 30 – 60
From 12 – 18: 12—16
Tachycardia:
Is a condition that makes your heart beat more than 100 times / minute
Brain stroke or brain attack:
Occurs when the blood supply to brain becomes blocked
Atherosclerosis:

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Dr. Mohammed Alruby
Is a condition where the arteries become narrowed and hardened due to a build up of plaque
around the artery wall, it is also known as arteriosclerotic vascular disease
Pneumonia:
Is an infection in one or both lungs, bacteria, virus, fungi
Emphysema:
Is a disease of the lungs, it occurs most often in smokers but it also occurs in people who regularly
breath in irritant
Endocarditis:
Rare condition that involves inflammation of heart lining, heart muscles and heart valves
Bacteremia:
Bacteria present in blood
Anorexia:
Is a serious mental illness where people are of low weight due to limiting their energy intake
It can affect any one of any age, gender, background
Osteoporosis:
Bone become weak and brittle.
Bulimia:
Is a serious mental illness where people are of high weight due to high food intake, it can affect
anyone, at any age
Diabetes Mellitus:
Metabolic disease that cause high blood sugar, the hormone insulin moves sugar from the blood
into your cells to be stored or used for energy
with diabetes, your body does not make enough insulin or cannot effectively use.
Types:
Type I: is an auto-immune disease, the immune system attacks and destroyed cells in pancreas,
where insulin is made
Type II: occurs when your body becomes resistant to insulin, and sugar builds up in your blood
Prediabetes: occurs when your sugar is higher than normal, but is not high enough for diagnosis
of type II
Gestational diabetes: is high blood sugar during pregnancy, insulin blocking hormones produced
by placenta cause this type of diabetes
Diabetes insipidus: not related to diabetes mellitus, it is different condition in which your kidneys
move too much fluid from your body
Periodontitis:
Gum disease, is a serious gum infection that damaged the soft tissue and can destroy the bone that
supports the teeth, can cause tooth loss
Gingivitis:
Mild form of gum disease, that cause irritation, redness and swelling of gingiva. If not treated can
lead to more serious gum disease
Hyperkalemia:
Serum potassium in blood is increased than normal that may lead to change the heart rhythm
Hypercalcemia:
High concentration of calcium in your blood. Calcium is essential for the normal function of organ,
cells, muscles and nerves. It is also important in blood clot
Hyperventilation:
Is fast breathing, people may breathe deeper than normal due to bleeding, severe pain, and lung
infection
Hyperthyroidism:

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Dr. Mohammed Alruby
Occurs when thyroid gland produces too much of thyroxine hormone
Can accelerate body metabolism, causing unintentional weight loss and rapid or irregular heart
beat
Hyperparathyroidism:
Occurs when parathyroid gland makes more parathyroid hormone PTH that regulate the level of
calcium, vit D and phosphorus in blood and bone
Leukemia:
Blood cancer caused by raise in the number of white blood cells in your body
WBC is a vital part of immune system that protect the body from invasion by bacteria, virus, fungi
Thrombocytopenia:
Low platelets count -- (colorless blood cells help to stop bleeding)
Pemphigus vulgaris:
Rare auto-immune disease that cause blistering on the skin and mucous membrane
Cataract:
Is clouding of normal clear lens of your eye for people who have cataract, seeing through cloudy
lenses
Glaucoma:
Damage of eye’s optic nerve, one of leading causes for blindness
Iritis:
Swelling and irritation in colored ring around eye’s pupil
Retinitis:
Term of eye disease that can lead to loss of sight
Colored vision issue:
Poor or deficient color vision, in ability to see the difference between certain color
Cavernous sinus thrombosis:
Blood clot blocks a vein that runs through a hollow space underneath the brain and behind the eye
socket, these veins carry blood from the face and head back to the heart
Orbital cellulitis:
Infection of the soft tissue within the eye socket, it is serious condition that without treatment can
lead to permanent vision loss
Double vision: diplopia:
Occurs when a person sees a double image where there should only be one
Heart Murmur:
Sound of blood flowing, it may be passing through an abnormal heart valve OR, the condition that
makes your heart beat faster and forces your heart to handle more blood quicker than normal
Mitral valve prolapses: MVP
Click Murmur syndrome or floppy valve syndrome
The condition in which the two valve flaps of mitral valve do not close smoothly or evenly
Angina pectoris:
Chest pain happens because there is not enough blood going to part of your heart, it like heart
attack with pressure or squeezing in your chest sometimes it called ischemic chest pain
Coronary angioplasty:
When heart arteries can block or narrow from a buildup of cholesterol, cells and other substances.
This can reduce blood flow to heart and cause chest discomfort
Angioplasty: opens blocked arteries and restore normal blood flow to heart muscle. It is not a
major surgery. It is done by threating a catheter (thin tube) through small puncture in a leg or arm
artery to heart, the blocked artery is opened by inflating a tiny balloon in it
Coronary bypass graft:

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Dr. Mohammed Alruby
Surgery to redirect blood around a section of a blocked artery in heart to improve blood flow to
heart muscles.
Rheumatic heart disease: RHD
A serious disease of heart involving damage to one or more of the four heart valves. The valve
damaged remain after an illness called acute rheumatic fever ARF
During ARF the heart tissue, and sometimes other parts of heart lining or muscles become swollen
and this called carditis, following carditis, the heart valves can remain damaged then become
scarred, and the result is an interruption to normal blood flow through damaged valves
Coronary thrombosis:
Formation of blood clot inside a blood vessels of the heart, this blood clot may then restrict blood
flow within the heart, leading to tissue damaged
Ischemic heart disease:
Is a condition of recurring chest pain or discomfort that occurs when a part of heart does not
receive enough blood, this condition occurs most often when heart requires greater blood flow
Hematologic disease:
Disorders which primarily affect the blood and blood forming organs, include rare genetic
disorder as:
- Disease of RBC: anemia
- Disease of WBC: leukemia
- Hemorrhagic disease: hemophilia
- Leucocyte disorders
- Blood platelets disorders
- Blood coagulation disorders
- Blood group incompatibility
Anemia:
Condition in which the number of red blood cells or hemoglobin concentration
Within them is lower than normal, hemoglobin is needed to carry oxygen and if you have too few
or abnormal red blood cells or not enough hemoglobin, there will be decreased capacity of blood
to carry oxygen to body tissues, this results in symptoms such as: fatigue, weakness and shortness
of breath
Blood coagulation factors:
I: fibrinogen
II: prothrombin
III: thromboplastin
IV: calcium
V: proaccelerin: labil factor
VI: unassigned factor
VII: proconvertin: stable factor
VIII: anti hemophilic factor: A B, globulin
IX: plasma thromboplastin component, Christmas factor
X: sturat factor- power factor
XI: plasma thromboplastin antecedent
XII: hegman factor: hemophilia C: Rosenthal syndrome
XIII: fibrin stabilizing factor: Laki lorand factor
Disease involving blood factors:

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Dr. Mohammed Alruby
1- Hemophilia:
It is a rare condition in which the blood does not clot properly, man is mostly affected
A: most affected type and is caused by deficiency in factor VIII
B: caused by deficiency of factor IX: Christmas factor
C: mild form of disease that caused by deficiency of factor XI
N: B:
Hemophilia: is an inherited genetic condition that is curable but it can be treated to minimize
symptoms and prevent future health complication
2- Pseudo-hemophilia:
Clotting disorder caused abnormal factor VIII activity and characterized by prolonged bleeding
time but without delayed coagulation
3- Para-hemophilia:
Owren’s disease: rare condition bleeding disorder that result in poor clotting after injury or
surgery due to defect in factor V or proaccelerin factor
Factor V: protein is made V: protein is made in liver that helps to convert prothrombin into
thrombin which is important in blood clotting process
4- Hypo-fibrinogenemia:
Fibrinogen: critical blood clotting factor I: it is rare disorder in which one of the two genes
responsible for producing fibrinogen unable to make functional fibrinogen because of an inherited
mutation
Type I: quantitative abnormalities: a fibrinogenemia and hypo-fibrinogen
Type II: qualitative abnormalities: hypodys-fibrinogenemia, dys-fibrinogenemia
5- Hypoprothrombinemia:
Rare blood disorder in which a deficiency in immune-reactive prothrombin (factor II) produced in
liver, results in impaired blood clotting reaction lead to an increased physiologic risk for
spontaneous bleeding
Types of anemia:
1- Iron deficiency anemia:
Caused by shortage of iron in your body- bone marrow needs iron to make hemoglobin and without
adequate iron the body cannot produce enough hemoglobin for red blood cells
2- Vitamin deficiency anemia:
Besides iron the body needs folate and vit B12 to produce enough healthy red blood cells, lacking
in these nutrient can cause decreased red blood cells production
3- Anemia of inflammation:
Certain disease such as cancer, HIV, AIDS and rheumatoid arthritis can interfere with the
production of red blood cells
4- A plastic anemia:
Rare anemia occurs when body does not produce enough red blood cells may caused by:
- Auto-immune disease
- toxic chemicals
- certain medicines
5- hemolytic anemia:
when blood cells are destroyed faster than bone marrow can replace them
6- sickle cell anemia:

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Dr. Mohammed Alruby
caused by defective form of hemoglobin that forces red blood cells to assume an abnormal crescent
shape (sickle) these irregular blood cells die prematurely, result in chronic storage of red blood
cells
7- thalassemia:
an inherited blood disorder that cause your body to have less hemoglobin than normal
Adrenal insufficiency: AI
The adrenal gland located on top of the kidneys make hormones that are essential for body
function, the outer-layer (cortex) of the gland makes three types of steroid hormones
Type I: also called Addison disease: rare condition, in which the adrenal gland do not make enough
cortisol (stress hormone)
Type II: secondary AI: more common type of AI, result when the pituitary gland. A small gland
near the brain does not signal the adrenal gland to make cortisol
Bronchial asthma:
Is a chronic inflammatory disorder in airway associated with airway hyper-responsiveness that
lead to recurrent episodes of wheezing, breathlessness, chest lightness and coughing particularly
at night in the early morning
chronic obstructive pulmonary disease: COPD:
is the name of a group of lung conditions that caused breathing difficulties, it include:
emphysema: damage to the air sac in the lung
chronic bronchitis: long term inflammation of airways
liver cirrhosis:
is a complication of liver disease that involves loss of liver cells and irreversible scaring of the
liver, cause weakness, loss of appetite, yellow skin
complication: swelling of the abdomen (ascites)
alcoholic liver disease:
refers to liver damage caused by excess alcohol intake
stages:
1- Alcoholic fatty liver disease
2- Alcoholic hepatitis
3- Cirrhosis
Renal failure:
Also called end stage of renal disease or the last stage of chronic disease
Kidney filter the blood and remove toxin from the body- kidney send toxins to your bladder which
the body later removes toxins during urination
Epilepsy:
Is a disorder of brain characterized by repeated seizures
Seizures: sudden alteration of the behavior due to temporary change in electric function of brain
Osteoradionecrosis:
Bone death due to radiation because radiation damaged the blood vessels of the bone

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Dr. Mohammed Alruby
Rare side effect, that develop some time after radiation therapy end. Mandible is more affected
side
Tuberculosis:
Bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected
person
It is mainly affects the lungs, but it can affect by any part of the body including, abdomen, gland,
bones and nervous system
Obstructive sleep apnea: OSA:
A condition in which breathing stops involuntary for brief periods of time during sleep
Normally: airflow smoothly from the mouth and nose into the lungs at all times
It occurs when the muscles that support the soft tissues in your throat such as tongue and soft
palate, temporarily relax so the airway is narrowed or closed and breathing is momentarily cut
Von willebrand disease: VWF
Von wellbrand factor: is synthetized and secreted by vascular endothelium to form part of
perivascular matrix
It is factor that promotes the platelets adhesion phase of hemostasis by binding with a receptor on
the platelets surface membrane
This disease can classify into:
Type 1: quantitative deficiency of VWF which of most common form of an autosomal disorder
Type II: qualitative impairment in synthesis of VWF that can result from various genetic
abnormalities and is an autosomal dominant disorder
Type III: a rare autosomal recessive disorder
Delirium:
State of mental confusion that starts suddenly and is caused by physical condition of some sort, it
difficult to remember, sleep, pay attention and more
Systemic disease caused by oral infection
= Foci of sepsis were responsible for the initiation and prognosis of a variety of inflammatory
disease such as arthritis, peptic ulcer
= teeth are the non-shedding surface on the body and bacterial levels can reach more than 10^11
micro-organisms
Bacteremia: presence of bacteria in blood stream, may result from ordinary activities as: vigorous
tooth brushing
Or infection: as urinary tract infection
Bacteremia can occur after tooth extraction, endodontic treatment, periodontal surgery and root
planning
== Several studies observed bacteremia:
100%: after extraction
70%: after dental scaling
55%: after third molar surgery
20%: after endodontic treatment
55%: after bacterial tonsillectomy

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Dr. Mohammed Alruby
Possible pathways of oral infection and non-oral disease:
1- Infection from oral cavity via transient bacteremia: to:
= subacute bacterial endocarditis
= brain abscess
= orbital cellulites
= skin ulcer, sinusitis
2- Metastasis from circulation of oral microbial toxins:
= acute cardial infarction
= cerebral infarction
= abnormal pregnancy outcome
= trigeminal neuralgia
3- Metastasis caused by immunological injury from oral organisms:
= chronic urticarial
= inflammatory bowel disease
Systemic disease associated with oral infection:
1- Cardiovascular disease:
As atherosclerosis and myocardial infarction
Mechanisms:
a- Oral bacteria as streptococcus and prophyromonus gingivitis induce platelets aggregation
which lead to thrombus formation
b- Lip- polysaccharides from periodontal organisms being transferred to the serum as a result
of bacteremia which have direct effect on endothelial parts
Periodontitis stimulate the liver to produce c-reactive protein CRP (marker of inflammation) which
in turn will form deposits on injured blood vessels
CRP binds the cells that are damaged and fixed complement
2- Infective endocarditis:
Bacterial infection of heart valve or endothelium of heart, it occurs when bacteria in blood stream
lodge on abnormal heart valve or damaged heart tissue
3- Myocardial infarction:
Damaging or death of an area of heart muscle resulting from reduced blood supply to that area
almost due to formation of an occlusive thrombus at the site of rupture of an alternates plaque in
coronary artery
4- Bacterial pneumonia:
An infection of pulmonary parenchyma caused by a wide variety of infectious agent, including
bacteria and fungi
Most commonly bacterial pneumonia result from aspiration of oropharyngeal flora into lower
respiratory tract
Pneumonia can result from infection by anaerobic bacteria, dental plaque would seem to be a
logical source of these bacteria, especially in patients with periodontal disease.
5- Low birth weight:
= changes in hormone levels during pregnancy promotes ab inflammation termed pregnancy
gingivitis

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Dr. Mohammed Alruby
= birth control pills may cause changes in alternation of micro-vasculature and gingival
permeability
= oral infection also seems to increase the risk for contribute to low birth weight in new born
6- Diabetes mellitus:
Is a risk factor for severe periodontal disease
Severe periodontal disease increases the severity of diabetes and complicate metabolic control
One may propose that control of chronic gram-ve periodontal infection should be part of standard
treatment of diabetic patient
Effect of oral health on systemic disease
Introduction:
Oral cavity are focal points for interaction of the body with the external environment
There are multiple surface types in the oral cavity and each is colonized with unique of 500—700
species of bacteria, virus, fungi
The level of oral hygiene significantly impacts the makeups of oral microbes
= individuals with good oral hygiene tends to have a simple flora dominated by g+ve cocci and
rods with some g-ve cocci
= individuals with poor oral hygiene have shift ti more diverse and complex flora dominated by
anaerobic g-ve organisms
= bacteria and saliva play a direct role in the development of the dental biofilm which commonly
referred to as plaque
= oral cavity bathed in complex mixture of fluids composed primarily of saliva and gingival
cervicular fluids that play a role in maintaining a healthy environment
= periodontal diseases are a group of chronic immune- inflammatory disease caused by bacteria
in biofilm
= periodontitis: the loss of CT and bone caused by persistence presence of pathologic bacteria in
biofilm, the bacteria accumulate in the pocket and pull the gingiva away from the teeth
(1)- atherosclerotic disease:
Patient with history of myocardial infarction or cerebro-vascular attacks have worse oral health
than control individual
Patient with severe gingival inflammation and frequent bacteremia which activate the lost
inflammatory response, this chronic inflammatory state trigger multiple cytokines as:
- C reactive protein
- Tumor necrosis factor
- Interleukin 1B
- Interleukin 6
Which in conjunction with bacteremia appear to stimulate the process of orthogenesis
= several studies have demonstrated that periodontal disease and poor oral hygiene have a strong
association with risk of coronary heart disease and acute myocardial infarction
= improvement of oral health decrease the risk of atherosclerotic disease
(2)- pulmonary diseases:
(3)- diabetes mellitus:
The relationship between diabetes and periodontal and periodontitis is truly bi-directional as it
well proven that hyperglycemia negatively impact glycemic control

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Dr. Mohammed Alruby
= individuals with diabetes have at least 3 times greater risk of periodontitis than those without
diabetes
= gingival pockets, deeper than 4mm are more common in diabetes than non-diabetic patient
= patient with pocket greater than 2mm deeper are at an increased risk of diabetes compared to
patient with pocket less than 1.3mm deep
= individuals with diabetes also suffer from: greater amount of bone loss, abscess formation, and
poor healing
Why diabetes affect mouth?
Prolonged exposure to hyperglycemia results in the production of advanced glycation and product
which have systemic impact that result in the increased execration of cytokines that leading to local
inflammation and loss of connective tissues
(4)- pregnancy:
= during pregnancy: gastric acid secretion and reflux of the acid into oral cavity leading to:
Enamel erosion
Xerostomia
Increased caries index
Increased teeth mobility and loss
= the changes in the gingiva that occur during pregnancy are associated with the changes in
estrogen and progesterone level
= the hormones cause capillary dilatation that results in gingival hypertrophy and inflammation,
also there is a change in the oral flora, including the increase in the amount of anaerobic bacteria,
these anaerobes initiate an inflammatory process that has systemic impact
= the presence of periodontal disease in the mother results in 7 times greater risk of this
complications
(5)- osteoporosis:
Decreased bone density in the jaw bone lead to greater alveolar bone resorption and increase
depth of pocket
(6)- kidney disease:
- periodontal disease
- poor oral health
Pathway linking oral infection to secondary non-oral disease
1- Metastatic infection:
Oral infection and dental procedure can cause transient bacteremia
The micro-organism that gain entrance to the blood and circulate throughout the body are usually
eliminated by the reticulo-endothelial system within minutes
2- Metastatic injury:
Some g+ve bacteria have the ability to produce diffusible protein or exotoxins which include
cytotoxic enzymes
The exotoxins have a specific pharmacological action and are considered the most powerful and
lethal poison known
3- Metastatic inflammation:
Soluble antigen may enter the blood stream, react with circulating specific antibody, and form a
molecular complex, these immune-complex may give rise to a variety of acute and chronic
inflammatory reactions at the sites of deposition

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Dr. Mohammed Alruby
Relations between dental health and eye
= infection and inflammatory process at the base of tooth could release inflammatory agent travel
to the eye lead to development of glaucoma
= toxic element of mercury filling have been found to cause the formation of cataract, retinitis,
iritis and color vision issue
= an infected tooth can cause pain and infection in other areas of your body including eyes
= spread of infection can also lead to cavernous sinus thrombosis
= spread of infection to eye socket through bone or veins can lead to orbital cellulitis
= toxic effect of mercury filling, fungal and bacterial infection from root canal and other
periodontal infection may directly contribute to vision loss
The microbes are neuro-toxic and can destroyed healthy nerve tissue in eye and brain